The coming era of change and some implications for the NHS research and development community

@HelenBevan #RDF2017
“Adding value together”
Working together
Helen Bevan

The Horizons team:
Change agents and change agency
• A small, diverse team of people within
NHS England who support large scale
change
• We tune into the latest change thinking and
practice in healthcare and other industries
around the world –translating this learning
into practical approaches to change
• The team has emerged through years of supporting
change in the NHS and the wider health and care system

We can see the seeds of radically different
futures in the present, just at the margins
FORECASTING
Focus on expected future
Future is an extension of
the present
Surprises come from
changes in the value of
known variables
Focus on range of futures
The present contains the
seeds of radically different
futures
Surprises come from
changes that disrupt the
system
FORESIGHT
Source: CoLab Alberta

The age of TOGETHERNESS
We are witnessing the collapse of expertise
and rise of collaborative sensemaking
David Holzmer
Source of image: ACCA

Change is changing

Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
We rarely see two, three or
four year change projects
any more. Now it’s 30-60-90
day change projects

Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
Pilots are being replaced by rapid tests
and prototypes

How we communicate and connect

The rising use of social analytics in
health and care

The 3% phenomena for change
Just 3% of people
in the organisation
typically drive
conversations with
90% of the other
people
Source: research by IC Kollectif

We still organise the health and care system
like the Tabulating Machine Co. of 1917
Source of image: @corp_rebels

Change is changing
Change is moving to
the edge

“Many times experts fail
because they are experts in
the past version of the world”
Vikram Khosia
@wellcometrust
#expertdebate

An example from the
Cabinet Office
http://www.slideshare.net/Openpolicymaking/060715-change-
cardscollated?next_slideshow=1

Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience and
background. Diversity leads to more
disruptive thinking, faster change
and better outcomes
Aylet Baron

The era of togetherness represents a
shift in power
Power is one’s
ability to achieve
goals
Bertrand Russell

Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

@HelenBevan #BPSconf
The Network Secrets of Great Change
Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important
than my position in the formal
hierarchy

POWER is linked to AGENCY
• The capacity of individuals to make their own
choices and to take action in a given environment
• Words that are connected to agency:
• Action
• Activity
• Effect
• Influence
• Power
• Choice

A big debate in social science
Structure versus Agency

Source: @NHSChangeDay

Source: @NHSChangeDay
Problematic:
changing a
“permission
culture” can
take years
The good news:
we can build
agency

Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in relationship
with others
Hahrie Han
Source of image: Idahoc Community Action

http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)

Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: patient activation,
shared decision-making
and self-care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust

WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
onesSource: adapted by Helen Bevan

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones
Source: adapted by Helen Bevan

What’s the evidence?
The failure of large scale
transformational change projects is
rarely due to the content or
structure of the plans that are put
into action
To make transformational change
happen we need to connect networks
of people who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role
of informal networks in the
organisations and systems
affected by change

Mark Jaben on the science behind resistance
What NOT to do
But what we do do
Engage
people here

Mark Jaben on the science behind resistance
What NOT to do
Instead of buyers (who “buy-in”),
we need investors
What TO do
Engage
people here
Engage
people here

“Resources” for change
Economic resources
diminish with use
• money
• materials
• technology
Social resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert
Hirschman and Marshall Ganz

A problem
Strategic leaders don’t see the resources
that we see in the system as solutions to
the biggest problems
Don Berwick

The era of the PLATFORM
Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value
John Hagel
Source of image: Pinipa

• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

The Change Challenge
Tapping the collective brilliance
of the NHS

14,000 contributions identified
10 barriers to change:
Confusing strategies
Over controlling
leadership
Perverse incentivesStifling innovation
Poor workforce
planning
One way
communication
Inhibiting
environment
Undervaluing staff
Poor project
management
Playing it safe

Front line teams get inundated with high priority
messages from leaders each day, making it
difficult for them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

Front line teams get inundated with high priority
messages from leaders each day, making it difficult for
them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Don’t overload front line staff with
strategies if you want improvements
in quality and safety
http://healthaffairs.org/blog/2014/03/07/the-
dangers-of-quality-improvement-overload-insights-
from-the-field/

14,000 contributions identified
11 building blocks for change:
Inspiring & supportive
leadership
Collaborative working
Thought diversityAutonomy & trust
Smart use of resources
Flexibility &
adaptability
Long term thinking
Nurturing our people
Fostering an open
culture
A call to action
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge” March 2015
Challenging the
status quo

After years of intensive analysis,
Google discovered that the key to high
performing teams that deliver change is
Psychological safety
Project Aristotle:
https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L

New Public
Passion:
a growing global
movement

....the last era of management was about how
much performance we could extract from
people
.....the next is all about how much humanity we
can inspire
Dov Seidman
The age of TOGETHERNESS

The coming era of change and some implications for the NHS research and development community

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